Friday, August 29, 2008

Cervical Spondylosis

Cervical spondylosis is a disorder caused by abnormal wear on the cartilage and bones of the neck (cervical vertebrae) with degeneration and mineral deposits in the cushions between the vertebrae (cervical disc). This condition is also known as Cervical osteoarthritis or Neck arthritis.

At the other extreme, cervical spondylosis may compress one or more of the spinal nerves branching out of the cervical vertebrae - a condition called cervical radiculopathy. Bone spurs and other irregularities caused by cervical spondylosis also may reduce the diameter of the canal that houses the spinal cord, resulting in cervical myelopathy. Cervical radiculopathy and cervical myelopathy can lead to permanent disability. Fortunately, most adults with cervical spondylosis - nearly 90 percent - will not lose nerve function, even temporarily.

Symptoms

Neck and shoulder pain are the most common symptoms. Types of neck and shoulder pain include:

· Stiff neck, most often one of the very first signs. Neck stiffness tends to grow progressively worse over time.· Radiating pain to the bottom of the skull (chronic sub-occipital headache) and/or to the shoulder and down the arm. This radiating pain may seem like a stabbing or a burning, or it might present itself as a dull ache.

Along with pain, cervical spondylosis can be accompanied by altered sensations and muscle weakness in the neck, shoulders, arms and hands, and a syndrome called “numb, clumsy hands”.

In cases of cervical spondylosis with myelopathy, the legs may be affected, leading to an interruption of stability while walking. Loss of balance might also occur. When myelopathy is present, incontinence may become a problem. Muscle wasting also accompanies cervical spondylosis with myelopathy.

Screening and DiagnosisYour symptoms and history, along with an examination, may suggest that you have cervical spondylosis.

Neck flexibility assessment. Cervical spondylosis limits the range of motion in your neck. To observe this effect, your doctor may have you tilt your head toward each of your shoulders and rotate your neck from side to side.

Neurological exam. To find out if there's pressure on your spinal nerves or spinal cord, your doctor will test your reflexes and make sure you have sensation all along your arms and legs. He or she may watch you walk to see if spinal compression is affecting your gait.

Neck or spinal X-ray. An X-ray may show abnormalities, such as bone spurs, that indicate cervical spondylosis.

Computerized tomography (CT) scan or magnetic resonance imaging (MRI). A CT scan of your spine uses X-ray technology, but produces a more detailed image than X-ray can. MRI uses a magnetic field and radio waves and can produce detailed, cross-sectional images of your spine. These tests may help your doctor determine the extent of damage to your cervical spine.

Myelogram. This test involves generating images using X-rays or CT scans after dye is injected into the spinal canal. The dye makes areas of your spine more visible.Causes, incidence, and risk factors:

Cervical spondylosis results from chronic degeneration of the cervical spine including the cushions between the neck vertebrae (cervical disks) and joints between the bones of the cervical spine. There may be abnormal growths or "spurs" on the vertebrae (the bones of the spine).

These accumulated changes caused by degeneration can gradually compress one or more of the nerve roots. This can lead to increasing pain in the neck and arm, weakness, and changes in sensation. In advanced cases, the spinal cord becomes involved. This can affect not just the arms, but the legs as well.

A previous neck injury (which may have occurred several years prior) can predispose to spondylosis, but the major risk factor is aging. By age 60, 70% of women and 85% of men show changes consistent with cervical spondylosis on x-ray.

PreventionYou may not be able to prevent cervical spondylosis. However, you may be able to reduce your risk by:

. Skipping high-impact activities, such as running, if you have any neck pain. Doing exercises to maintain neck strength, flexibility and range of motion. Taking breaks when driving, watching TV or working on a computer to keep from holding your head in the same position for long periods. Practicing good posture, with your neck aligned over your shoulders. Protecting your neck from injury by using a seat belt when in a car

Self Care

For mild neck pain or stiffness:

. Take a long, hot shower every day. Use hot fomentation aound the neck and shoulder. Wear a cervical collar during the day. Regularly walk or engage in low-impact aerobic activityTreatment

The goal of treatment is relief of pain and prevention of permanent spinal cord and nerve root injury.

Symptoms from mild cervical spondylosis usually stabilize or regress with simple therapy including a cervical collar (neck brace) to restrict motion and doing prescribed exercises to strengthen neck muscles and stretch the neck and shoulders. Low-impact aerobic exercise, such as walking or water aerobics, also may help. For acute cases, complete bedrest and traction for 1 or 2 weeks may be needed.